Medicine is a rapidly changing field that requires practitioners to expend immense effort in an attempt to maintain and use the most up-to-date knowledge. Clinicians have countless journals, books, and online resources from which to choose and can be easily overwhelmed when trying to assess the available published data and make evidence-based clinical decisions. Because of this explosion in medical literature, evidence-based medicine developed as a necessity to help practitioners stay abreast of important breakthroughs and help busy frontline providers apply the best evidence when making decisions for their patients.
The Eastern Association for the Surgery of Trauma (EAST) was an early leader in evidence-based medicine. In 1994, EAST President Michael Rhodes (Fig. 1) gave his presidential address titled “Practice Management Guidelines for Trauma Care1” and created the EAST Practice Management Guidelines (PMGs) Ad Hoc Committee, with Dr. Rhodes as the inaugural chair. This ad hoc committee has been functioning continuously since then under the leadership of Drs. Michael D. Pasquale, Fred A. Luchette, and William “Bill” Bromberg. Most recently, we have been honored to be the immediate past (Andrew J. Kerwin) and current (Elliott R. Haut) PMG Ad Hoc Committee chairs at EAST. This committee developed a standard approach to PMG development and published “Utilizing Evidence-Based Outcome Measures to Develop Practice Management Guidelines: A Primer2” in 2000. This article described the process that EAST used to create PMGs and outlined a nine-step process by which evidence-based reviews could be conducted and used as part of a mature quality assessment program. PMGs have been presented at the EAST Annual Scientific Assembly since 2001, and many have been published in The Journal of Trauma and Acute Care Surgery.
Today, EAST is widely recognized internationally for its evidence-based medicine approach and, specifically, its PMGs. EAST PMGs now cover the full spectrum of acute care surgery-trauma, surgical critical care, and emergency general surgery and also include evidence-based reviews on injury prevention topics. The EAST PMG Web site (http://www.east.org/resources/treatment-guidelines) receives approximately 2,000 hits per month and serves as the repository for dozens of PMGs that are freely available to all. These PMGs have been the basis for countless quality improvement initiatives at trauma programs and in emergency departments across the country and throughout the world. It is important to remember that PMGs may not apply to every patient situation and must be used in combination with clinical judgment. Individual patient scenarios, resource availability, and clinical variations need to be taken into account when making patient care decisions. There is no doubt that the extraordinary work by EAST members has benefited patients worldwide.
This supplement to The Journal of Trauma and Acute Care Surgery was compiled by the members of the EAST Practice Management Guidelines Ad Hoc Committee to serve two important purposes. First, the ad hoc committee wanted to widely disseminate new and updated PMGs to standardize and improve patient care. In this supplement, readers will find 12 EAST PMGs. The topics include seven trauma, four critical care, and one acute care surgery. Second, EAST needed to update its previous approach to grading evidence and making recommendations for PMG development, which has been used since 2000. To that end, an article in this supplement introduces EAST members and other readers to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system,3 which will be used in all subsequent PMGs published after this supplement. This method provides a rigorous approach to guideline development that is transparent, reproducible, and clear. GRADE has been adopted by more than 60 national and international organizations. To keep EAST’s position as a leader in guideline promulgation, EAST has adopted GRADE for use in the development of all future EAST PMGs.
This EAST PMG supplement would not have been possible without the hard work of many individuals both within EAST and from The Journal of Trauma and Acute Care Surgery. Dr. Donald H. Jenkins, EAST president 2010, deserves special recognition. Dr. Jenkins was responsible for spearheading the concept of a PMG supplement and worked closely with Dr. Basil A. Pruitt, Jr., the former editor of The Journal of Trauma and Acute Care Surgery, for this supplement to come to fruition. Subsequent EAST presidents Dr. Erik S. Barquist and Dr. Jeffrey P. Salomone have continued to make this supplement a priority for EAST. They helped garner ongoing support from the current editor Dr. Ernest “Gene” Moore and managing editor Jennifer Crebs of The Journal of Trauma and Acute Care Surgery to make this publication a reality. We gratefully acknowledge the tireless work of Christine Eme, EAST executive director, who has helped to “herd the cats” and keep us on track to complete this project. We greatly appreciate the EAST Board and the EAST Foundation who provided the emotional, intellectual, and financial support that has resulted in this publication. Finally, this journal supplement and all EAST PMGs would not be possible without the commitment of countless EAST members who have volunteered their expertise, time, and knowledge to develop the PMGs. We hope that this body of work will continue to educate physicians, residents, fellows, advanced practitioners, nurses, students, and patients in many aspects of trauma and acute care surgery and help these providers deliver topnotch care to all patients for years to come.
The authors declare no conflicts of interest. E.R.H. is the PI of a Mentored Clinical Scientist Development Award K08 1K08HS017952-01 from the AHRQ entitled “Does Screening Variability Make DVT an Unreliable Quality Measure of Trauma Care?” E.R.H. receives royalties from Lippincott, Williams, Wilkins for a book - “Avoiding Common ICU Errors” E.R.H. has given expert witness testimony in various medical malpractice cases.
1. Rhodes M. Practice management guidelines for trauma care: presidential address, Seventh Scientific Assembly of the Eastern Association for the Surgery of Trauma. J Trauma
. 1994; 37: 635–644.
2. Eastern Association for the Surgery of Trauma Ad Hoc Committee on Practice Management Guideline Development. Utilizing evidence based medicine outcome measures to develop practice management guidelines: a primer
. EAST; 2000. Available at: www.east.org/content/documents/east_pmg_primer.pdf
3. Kerwin AJ, Haut ER, Burns JB, Como JJ, Haider A, Stassen N, Dahm P and the Eastern Association for the Surgery of Trauma Practice Management Guidelines Ad Hoc Committee. The Eastern Association for the Surgery of Trauma approach to practice management guideline development using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. J Trauma Acute Care Surg
. 2012; 73: S283–S285.